Competence in Delivering Cognitive Processing Therapy and the Therapeutic Alliance Both Predict PTSD Symptom Outcomes

Cognitive Processing Therapy (CPT) is efficacious in treating PTSD, but there remains a need to improve outcomes for individuals who do not fully respond to treatment. Differences between patient-therapist dyads in the fidelity (i.e., adherence and competence) of CPT delivery and the quality of the therapeutic relationship may partly explain differential levels of symptom improvement. Sessions were sampled from a randomized trial comparing different consultation conditions in training therapists new to CPT. Among 69 patients, one session from Sessions 1–3 and one session from Sessions 4–7 were reliably rated for adherence and competence using the CPT Therapist Adherence and Competence Scale, and for therapeutic alliance using the Working Alliance Inventory-Observer scale. Mixed models, including detrending using a fixed effect of session, predicted self-reported Posttraumatic Stress Disorder Checklist (PCL-IV) scores in one session using process scores from the previous session. The statistical interaction between fidelity and alliance scores to predict outcome was also examined. Alliance had significant, positive correlations (rs = 0.18–0.21) with same-session adherence and competence. Higher competence scores and higher therapeutic alliance scores in one session were independently associated with lower PCL-IV scores in the subsequent session. Adherence scores, which tended to be very high with relatively less variability, did not significantly relate to subsequent-session PCL-IV scores. Competence significantly interacted with alliance, such that sessions high in both competence and alliance predicted especially lower subsequent-session PCL-IV scores. A strong therapeutic alliance may have a synergistic, salutary effect with the competent delivery of CPT.     

Advanced driver assistance systems (ADAS): Demographics,preferred sources of information,and accuracy of ADAS knowledge

Advanced driver assistance systems (ADAS) in passenger vehicles can improve highway safety. ADAS place powerful, yet imperfect, automation in the hands of drivers who hold both misconceptions and reservations about ADAS. There is little previous research on drivers’ knowledge of ADAS, and even less on sources of information drivers use to inform their knowledge. The present study addressed this gap, testing hypotheses about influences on understanding of seven ADAS in 634 licensed US drivers (aged 18–82). Multiple regression to predict self-assessed driver characteristics revealed: (a) Drivers who rated themselves as more technically sophisticated tended to be young and male, to be at once less objectively knowledgeable and more confident of their knowledge of ADAS, to avoid car dealers for ADAS information, and to value brand status; (b) Drivers who rated themselves as faster to adopt new technology also tended to be male but to be more objectively knowledgeable about ADAS and to prefer learning about ADAS from owner manuals; (c) Drivers who rated themselves as more confident in using novel vehicle technology tended to be young males with greater objective knowledge of ADAS who valued “hands-on” ADAS experience; (d) Drivers who rated themselves as more concerned about vehicle safety tended to be female, to value crash data, and to rely on hands-on experience to learn about ADAS; (e) Drivers who rated themselves as having greater aesthetic concerns tended to rely on information on styles, colors, wheels when buying a new car and preferred specific ADAS components. Neither of the latter two differed in objective ADAS knowledge. These results make a novel contribution in revealing how driver demographics and characteristics are related to preference for specific sources of information on ADAS and objective knowledge of ADAS. These results can inform future efforts to increase driver understanding of the capabilities and limitations of ADAS and hence increase public safety.     

Evaluating single-case research data for systematic review: A commentary for the special issue

The purpose of this commentary is to provide observation on the statistical procedures described throughout this special section from the perspective of researchers with experience in conducting systematic reviews and meta-analyses of single-case research to address issues of evidence-based practice. It is our position that both visual and statistical analyses are complimentary methods for evaluating single-case research data for these purposes. Given the recent developments regarding the use of single-case research to inform evidence-based practice and policy, the developments described in the present issue will be contextualized within the need for a widely accepted process for data evaluation to assist with extending the impact of single-case research. The commentary will, therefore, begin with providing an overview of the conceptual underpinnings of a systematic review of single-case research and will be followed by a discussion of several features that are essential to the development of a conceptually sound and widely used statistical procedure for single-case research. The commentary will conclude with recommendations and guidelines for the use of both visual and statistical analyses within primary research reports and recommendations for future research.     

Meta- and statistical analysis of single-case intervention research data: Quantitative gifts and a wish list

In this commentary, we add to the spirit of the articles appearing in the special series devoted to meta- and statistical analysis of single-case intervention-design data. Following a brief discussion of historical factors leading to our initial involvement in statistical analysis of such data, we discuss: (a) the value added by including statistical-analysis recommendations in the What Works Clearinghouse Standards for single-case intervention designs; (b) the importance of visual analysis in single-case intervention research, along with the distinctive role that could be played by single-case effect-size measures; and (c) the elevated internal validity and statistical-conclusion validity afforded by the incorporation of various forms of randomization into basic single-case design structures. For the future, we envision more widespread application of quantitative analyses, as critical adjuncts to visual analysis, in both primary single-case intervention research studies and literature reviews in the behavioral, educational, and health sciences.     

Feasibility of a Community Intervention for the Prevention of Suicide and Alcohol Abuse with Yup’ik Alaska Native Youth: The Elluam Tungiinun and Yupiucimta Asvairtuumallerkaa Studies

The Elluam Tungiinun and Yupiucimta Asvairtuumallerkaa studies evaluated the feasibility of a community intervention to prevent suicide and alcohol abuse among rural Yup’ik Alaska Native youth in two remote communities. The intervention originated in an Indigenous model of protection, and its development used a community based participatory research process. Feasibility assessment aimed to assess the extent to which (1) the intervention could be implemented in rural Alaska Native communities, and (2) the intervention was capable of producing measurable effects. Scales maximally sensitive to change were derived from earlier measurement work, and the study contrasted implementation process and outcomes across the two communities. In one community, medium dose response effects (d = .30–.50), with dose defined as number of intervention activities attended, were observed in the growth of intermediate protective factors and ultimate variables. In the other community, medium dose effects were observed for one intermediate protective factor variable, and small dose effects were observed in ultimate variables. Differences across communities in resources supporting intervention explain these contrasting outcomes. Results suggest implementation in these rural Alaska settings is feasible when sufficient resources are available to sustain high levels of local commitment. In such cases, measureable effects are sufficient to warrant a prevention trial.     

More than meets the eye: a consideration of the influence of a counsellor's visual impairment upon his therapeutic relationships

Other than through personal reflection and anecdotal evidence, I have had little opportunity to explore the influence of my visual impairment upon my therapeutic relationships. In order to address this, I conducted three research conversations with former clients (participants), each of whom had expressed an interest in participating in the research. Potential participants also had to meet the inclusion criteria for the research and provide informed consent prior to their participation. Research conversations were conducted between March and July 2009 and were analysed qualitatively, using a method informed by Moustakas's heuristic inquiry. Participants demonstrated idiosyncratic responses to my visual impairment; their perception of their responses to my visual impairment sometimes differed from mine. Feelings identified included uncertainty, disappointment and relief. My visual impairment appeared to influence the therapeutic relationship in a variety of ways, including resonance with the inner world significance of disability to the participant and interaction with my personal process. While not the therapeutic agent, my visual impairment had the potential to act as a catalyst in therapeutic change. The potential for me to either under-estimate or over-estimate the significance of my visual impairment highlights the need for continued self-awareness and the maintenance of an open and non-defensive attitude.     

Anticipating action effects recruits audiovisual movement representations in the ventral premotor cortex

When table tennis players anticipate the course of the ball while preparing their motor responses, they not only observe their opponents striking the ball but also listen to events such as the sound of racket–ball contact. Because visual stimuli can be detected more easily when accompanied by a sound, we assumed that complementary sensory audiovisual information would influence the anticipation of biological motion, especially when the racket–ball contact is not presented visually, but has to be inferred from continuous movement kinematics and an abrupt sound. Twenty-six observers were examined with fMRI while watching point-light displays (PLDs) of an opposing table tennis player. Their task was to anticipate the resultant ball flight. The sound was presented complementary to the veracious event or at a deviant time point in its kinematics.Results showed that participants performed best in the complementary condition. Using a region-of-interest approach, fMRI data showed that complementary audiovisual stimulation elicited higher activation in the left temporo-occipital middle temporal gyrus (MTGto), the left primary motor cortex, and the right anterior intraparietal sulcus (aIPS). Both hemispheres also revealed higher activation in the ventral premotor cortex (vPMC) and the pars opercularis of the inferior frontal gyrus (BA 44). Ranking the behavioral effect of complementary versus conflicting audiovisual information over participants revealed an association between the complementary information and higher activation in the right vPMC. We conclude that the recruitment of movement representations in the auditory and visual modalities in the vPMC can be influenced by task-relevant cross-modal audiovisual interaction.     

医学科研与医学科学的发展——高校附属医院SCI热的利弊分析

针对当前我国各大医院普遍出现的《科学引文索引》(science citation index,SCI)热,对高等医学院校附属医院进行调查研究,从医学科研与医学科学的发展、医院SCI热的利弊,及未来规划三个方面进行详细分析.客观说明对科研工作者的科研成绩进行公正、合理的评价,反对单纯以发表论文数量评价个人学术水平和贡献的做法.只有这样才可以充分调动科研工作者的科学探索兴趣和热情,还科学研究以本来的面目,促进科研管理水平再上新台阶.